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Age-dependent error in creatinine clearance estimated by Cockcroft–Gault equation for the elderly patients in a Japanese hospital: a cross-sectional study

  • Mitsuhiro MatsuoEmail author
  • Fuminori Yamagishi
Short Communication
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Abstract

The aim of this study is to assess the accuracy of creatinine clearance (CCr) calculated by the Cockcroft–Gault (CG) equation for elderly patients in a Japanese hospital. This study was a retrospective chart review of patients aged ≥ 55 years with a CCr measurement by a 24-h urine collection (24-h) prior to general surgery in our hospital between April 2009 and March 2017. In total, 1028 Japanese patients were included (mean age 73.0 ± 8.9 years). The serum creatinine value was 0.82 ± 0.24 mg/dL. The CCr estimated by CG and measured by 24 h was 64.2 ± 20.9 mL/min and 71.5 ± 21.0 mL/min, respectively. The CG CCr was significantly underestimated in patients aged ≥ 65 years, and the discrepancy exhibited an age-dependent character. The error was reached at 21.7 ± 13.2 mL/min in patients aged ≥ 90 years (P < 0.001). The age-dependent errors almost completely disappeared when the modified CG equation was used, in which the term of age in the original CG equation was constantly regarded as 65, if the patient was 65 years or older. Anesthesiologists and intensivists should pay attention to the potential risk of underestimating kidney function when using the CG equation for Japanese elderly patients.

Keywords

Aged Bias Kidney function Preoperative evaluation 24-h urine collection 

Notes

Author contributions

MM designed and performed the research; preparing manuscript was supervised by YF.

References

  1. 1.
    The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.CrossRefGoogle Scholar
  2. 2.
    Baldea AJ. Effect of aging on renal function plus monitoring and support. Surg Clin N Am. 2015;95:71–83.CrossRefGoogle Scholar
  3. 3.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.CrossRefGoogle Scholar
  4. 4.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.CrossRefGoogle Scholar
  5. 5.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.CrossRefGoogle Scholar
  6. 6.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefGoogle Scholar
  7. 7.
    Raman M, Middleton RJ, Kalra PA, Green D. Estimating renal function in old people: an in-depth review. Int Urol Nephrol. 2017;49:1979–88.CrossRefGoogle Scholar
  8. 8.
    Verhave JC, Fesler P, Ribstein J, du Cailar G, Mimran A. Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis. 2005;46:233–41.CrossRefGoogle Scholar
  9. 9.
    Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft–Gault equation. Pharmacotherapy. 2012;32:604–12.CrossRefGoogle Scholar
  10. 10.
    Demirovic JA, Pai AB, Pai MP. Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm. 2009;66:642–8.CrossRefGoogle Scholar
  11. 11.
    Chaverri-Fernández JM, Zavaleta-Monestel E, Díaz-Madriz JP, Ortiz-Ureña A, Ramírez-Hernández M, Trejos-Morales K. Analysis of the concordance between the estimated values of creatinine clearance using the Cockcroft–Gault equation and the real value determined in patients from the Hospital Clínica Bíblica. Farm Hosp. 2016;40:3–13.PubMedGoogle Scholar
  12. 12.
    Hubner RA, Goldstein R, Mitchell S, Jones A, Ashley S, O’Brien ME, Popat S. Influence of co-morbidity on renal function assessment by Cockcroft–Gault calculation in lung cancer and mesothelioma patients receiving platinum-based chemotherapy. Lung Cancer. 2011;73:356–60.CrossRefGoogle Scholar
  13. 13.
    Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28:830–8.CrossRefGoogle Scholar
  14. 14.
    Stevens LA, Coresh J, Feldman HI, Greene T, Lash JP, Nelson RG, Rahman M, Deysher AE, Zhang YL, Schmid CH, Levey AS. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol. 2007;18:2749–57.CrossRefGoogle Scholar
  15. 15.
    Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, Townsend R, Okparavero A, Zhang YL, Schmid CH, Levey AS, Chronic Kidney Disease Epidemiology Collaboration. Chronic Kidney Disease Epidemiology Collaboration. Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations. Am J Kidney Dis. 2009;54:33–42.CrossRefGoogle Scholar
  16. 16.
    Kanda I, Kawasaki A, Morita R, Musha M, Sakurada T, Kobayashi E, Satoh N. Survey on “renal function” information in the package inserts of prescription drugs (in Japanese with English abstract). Jpn J Clin Pharmacol Ther. 2013;44:313–8.CrossRefGoogle Scholar
  17. 17.
    Miller WG, Myers GL, Ashwood ER, Killeen AA, Wang E, Thienpont LM, Siekmann L. Creatinine measurement: state of the art in accuracy and interlaboratory harmonization. Arch Pathol Lab Med. 2005;129:297–304.PubMedGoogle Scholar
  18. 18.
    Dowling TC, Wang ES, Ferrucci L, Sorkin JD. Glomerular filtration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore Longitudinal Study on Aging: impact on renal drug dosing. Pharmacotherapy. 2013;33:912–21.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyItoigawa General HospitalItoigawaJapan
  2. 2.Department of SurgeryItoigawa General HospitalItoigawaJapan

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